ABSTRACT
Cirrhosis is a chronic condition that can lead to liver failure. Currently, the viable option for decreasing mortality is liver transplantation. However, transplant surgery is highly invasive. Therefore, cell-based therapy has been developed as an alternative. Based on promising findings from preclinical research, some new trials have been registered. One of them was autologous bone marrow cell infusion therapy and found that ameliorating liver fibrosis activated liver regeneration. Now, majority of trials focus on low-immunogenicity mesenchymal stem cells (MSCs) appropriate for allogeneic administration. However, despite about 20 years of research, only a limited number of cell-based therapies have entered routine practice. Furthermore, potential shortcomings of cell-based therapy include a limit on the number of cells, which may be administered, as well as their failure to infiltrate target organs. On the other hand, these research show that MSCs act as “conducting cells” and regulate host cells including macrophages via extracellular vesicles (EVs) or exosome signals, leading to ameliorate liver fibrosis and promote regeneration. Therefore, the concept of cell-free therapy, which makes use of cell-derived EVs or exosomes, is attracting attention. Cell-free therapies may be safely administered in large doses and are able to infiltrate target organs. However, development of cell-free therapy exhibits its own set of challenges and such therapy may not be completely curative in the context of liver disease. This review describes the history of cell-based therapy research and recent advances in cell-free therapy, as well as discussing the need for more effective therapies.
ABSTRACT
Objective: Scrub typhus is a relatively common life-threating disease; its symptoms are non-specific and similar to those of other viral infections. Therefore, scrub typhus might be underdiagnosed.Patient: Herein, we report a patient with scrub typhus whose clinical course mimicked that of infectious mononucleosis. A 63-year-old male patient with hypertension presented to our hospital complaining of symptoms including prolonged fever, pharyngeal discomfort, and a mild headache. He showed the appearance of a rash after amoxicillin administration. At the same time, he did not show a crusted rash on his body surface.Results: After a comprehensive examination, Epstein-Barr virus and cytomegalovirus infections were ruled out. We suspected that this patient suffered from scrub typhus on the basis of his usual lifestyle. Finally, polymerase chain reaction analysis showed a positive result for deoxyribonucleic acid of Orientia tsutsugamushi in his blood sample. Fortunately, he recovered naturally with only supportive treatment during his hospitalization.Conclusion: We should observe and monitor patients with infectious mononucleosis-like symptoms and emphasize the importance of a clinical interview.
ABSTRACT
Superior vena cava syndrome (SVCS), which is characterized by facial edema and congestion of the head, upper extremities, and neck, is a life-threatening oncologic emergency. Although a combination of chemotherapy and radiation therapy has been considered as the standard treatment for SVCS, stent implantation to the superior vena cava (SVC) has been recently developed to alleviate edema or dyspnea caused by SVCS. On the other hand, stent implantation to the SVC requires skilled interventional cardiologists or radiologists. In general, those specialists reside in university hospitals or large hospitals in an urban area. In this case report, an 86-year-old man underwent stent implantation to a stenosed SVC in a rural area. Because the patient refused the transfer to the core, urban hospital, we invited a skilled interventional cardiologist from the core hospital and performed stent implantation to the SVC in a small, rural hospital. It is generally difficult to perform stent implantation for SVCS in a small hospital, because skilled operators in the field of interventional cardiology or radiology do not usually perform operations in smaller facilities. Our case indicates the importance of cooperation between rural generalists and urban specialists.
ABSTRACT
<p>Acute symptomatic deep vein thrombosis (DVT) is usually managed by intravenous heparin and oral warfarin. Recently, direct oral anticoagulants (DOAC) have been introduced for the treatment of acute DVT. DOAC may be useful for very elderly patients who live in rural areas, where medical resources are limited. An 83-year-old woman presented to our clinic with left leg edema. Contrast enhanced computed tomography showed massive deep vein thrombosis in her left internal iliac vein. We diagnosed her with acute deep vein thrombosis. Since she refused to be hospitalized, we treated her with rivaroxaban as an outpatient. She had a good clinical course without hospitalization or an adverse event. DOAC may be useful for very elderly patients in rural areas.</p>
ABSTRACT
<b>Objective/Design:</b> The purpose of this study was to confirm the effect of herbal tea therapy (HTT) on Ménière’s disease, especially, about the quality of life (QOL). We studied 26 patients with Ménière’s disease who came to the International University of Health and Welfare MITA hospital between 2007 and 2008.<br> <b>Methods:</b> We divided subjects into two groups, one with 16 patients treated with herbal tea (HTT group) and one with 10 patients treated without herbal tea (non-HTT group). All patients were diagnosed as having Ménière’s disease and underwent otoneurologic examination, audiometric measurements, questionnaires of functional level and tinnitus every month. Moreover, we instructed these patients to keep a record of the number of times vertigo was experienced. In the HTT group, after 6 months of general treatment, we treated patients with herbal tea for one year. This herbal tea was effective as a diuretic, in promoting antivertigo, antistress, and relaxation. We compared results before and after HTT. Moreover, based on SF-36 questionnaires, we compared clinical symptoms between groups.<br> <b>Result:</b> HTT reduced the percentage of relapse and improved their Ménière’s symptoms, especially vertigo. QOL scores, especially for mental function, were higher in the HTT group than in the non-HTT group.<br> <b>Conclusion:</b> We thought that HTT might improve their mental health or stress and prevent worsening of Ménière’s disease.<br>
ABSTRACT
<b>Objective/Design</b>: The purpose of this study was to confirm the effect of herbal tea therapy on Ménière’s disease. We studied 15 patients with Ménière’s disease who came to the International University of Health and Welfare MITA hospital between 2007 and 2008.<br> <b>Methods</b>: According to criteria of the Japan Society for Equilibrium Research, all patients were diagnosed as having Ménière’s disease and underwent otoneurologic examination, audiometric measurements, questionnaires of functional level and tinnitus every month. Moreover, we instructed these patients to keep a record of the number of times vertigo was experienced. After 6 months of general treatment, we treated patients with herbal tea for one year. This herbal tea was effective as a diuretic, in promoting antivertigo, and relaxing. We compared results before and after herbal tea therapy.<br> <b>Result</b>: Herbal tea therapy was effective in about 10 patients, but 5 patients relapsed. However, symptom of the relapsed patients improved after using less medicine, although the quantity of medication was less than before starting the herbal tea therapy. Herbal tea therapy improved their Ménière’s symptoms, especially vertigo after 6 months from starting herbal tea therapy.<br> <b>Conclusion</b>: Our study provides evidence that herbal tea therapy is useful for preventing worsening of Ménière’s disease.<br>